诱导化疗联合同步放化疗序贯辅助化疗治疗局部晚期鼻咽癌的近远期疗效及安全性

Short-term and long-term efficacy and safety of induction chemotherapy combined with concurrent chemoradiotherapy and sequential adjuvant chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma

目的探讨诱导化疗联合同步放化疗序贯辅助化疗对局部晚期鼻咽癌患者的近远期疗效及安全性。方法选取216例局部晚期鼻咽癌患者,观察其诱导化疗治疗后、同步放化疗治疗后、辅助化疗治疗后的近期疗效和治疗期间的不良反应。随访1年,观察患者的1年生存率、1年局部复发率和1年远处转移率,并对TNM分期为Ⅲ期患者进行分层分析(分为T1-2N2M0组104例,T3N0-2M0组88例)。结果诱导化疗+同步放化疗后患者的客观缓解率(ORR)为88.0%,诱导化疗+同步放化疗+辅助化疗后患者的ORR为91.2%,均明显高于诱导化疗后患者的ORR(51.9%),差异均有统计学意义(P﹤0.01)。诱导化疗期间白细胞减少(39.4%)和恶心呕吐(35.2%)的发生率均较高,同步放化疗期间口腔黏膜炎(100%)、恶心呕吐(96.8%)和白细胞减少(95.8%)的发生率均较高,辅助化疗期间白细胞减少(98.1%)、恶心呕吐(85.6%)和血小板减少(59.7%)的发生率均较高。TNM分期为Ⅲ期和ⅣA期鼻咽癌患者的1年生存率分别为93.8%和87.5%,1年局部复发率分别为2.1%和4.2%,1年远处转移率分别为12.5%和20.8%。T1-2N2M0组和T3N0-2M0组患者的1年生存率、1年局部复发率和1年远处转移率比较,差异均无统计学意义(P﹥0.05)。结论诱导化疗+同步放化疗+辅助化疗治疗局部晚期鼻咽癌疗效显著,但需要关注患者治疗期间的不良反应。

Objective To explore the short-term and long-term efficacy and safety of induction chemotherapy combined with concurrent chemoradiotherapy and sequential adjuvant chemotherapy in patients with locally advanced nasopharyngeal carcinoma.Method A total of 216 patients with locally advanced nasopharyngeal carcinoma were included in the research.The short-term efficacy were observed after induction chemotherapy,concurrent chemoradiotherapy,and sequential adjuvant chemotherapy,respectively,besides,the incidence of adverse reactions during treatment was also evaluated.These patients were followed up for 1 year,the 1-year survival rate,1-year local recurrence rate,and 1-year distant metastasis rate were investigated,additionally,patients with TNM stage III diseases were stratified[as T1-2N2M0 group(n=104)and T3N0-2M0 group(n=88)]for further analysis.Result The overall response rate(ORR)after induction chemotherapy+concurrent chemoradiotherapy was 88.0%,and it was 91.2%after induction chemotherapy+concurrent chemoradiotherapy+adjuvant chemotherapy,both were higher than that after only induction chemotherapy at 51.9%,with statistically significant differences observed(P<0.01).During induction chemotherapy,the incidence of leukocytopenia(39.4%),nausea and vomiting(35.2%)were relatively higher,during concurrent chemoradiotherapy,oral mucositis(100%),nausea and vomiting(96.8%)and leukocytopenia(95.8%)were the commonest,while during adjuvant chemotherapy,main adverse reactions included leukocytopenia(98.1%),nausea and vomiting(85.6%)and thrombocytopenia(59.7%).The 1-year survival rate of patients with stageⅢandⅣA nasopharyngeal cancer was 93.8%and 87.5%,the 1-year local recurrence rate was 2.1%and 4.2%,and the 1-year distant metastasis rate was 12.5%and 20.8%,respectively.Besides,the 1-year survival rate,1-year local recurrence rate,and 1-year distant metastasis rate between patients with T1-2N2M0 and T3N0-2M0 stage diseases were of no statistical significant difference(P>0.05).Conclusion Induction chemotherapy+concurrent chemoradiotherapy+adjuvant chemotherapy is a feasible regimen for the treatment of locally advanced nasopharyngeal carcinoma,while the adverse reactions during treatment should be addressed.